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APPENDIX H:
SEVEN-DAY WAITING PERIOD
The following methods of
calculating the seven-day waiting period are acceptable for purposes of Board
audits:
In the case of ongoing total
incapacity, the seven-day waiting period is met when the employee is incapacitated
for seven calendar days. In the case of partial incapacity, the seven-day
waiting period is met when (1) [AWW Method] an employee loses wages because of
the injury which cumulatively equal or exceed the employee’s pre-injury AWW, or
(2) [Comp Rate Method] loses wages because of the injury that would otherwise
require the insurer to pay one week of benefits.
In the case of ongoing total
incapacity, the seven-day waiting period becomes compensable when the employee
is incapacitated for more than 14 calendar days. In the case of partial
incapacity, the seven-day waiting period becomes compensable when (1) [AWW
Method] an employee loses wages because of the injury which cumulatively exceed
two times the employee’s pre-injury AWW, or (2) [Comp Rate Method] loses wages
because of the injury that would otherwise require the insurer to pay more than
two weeks of benefits.
Example: Assume January 1999 date of injury, married/joint with
one dependent filing status.
Weekly
Compensation Rate
Pre-Injury AWW $650.00 $417.00
Post-Injury Wage $450.00 $302.52
$114.48 Partial Weekly Benefit Rate
AWW Method
|
|
Pre-injury AWW |
Post-injury AWW |
Lost Earnings |
Cumulative Lost Earnings |
Weekly Benefits Due |
|
Week 1 |
$650.00 |
$450.00 |
$200.00 |
$200.00 |
|
|
Week 2 |
$650.00 |
$450.00 |
$200.00 |
$400.00 |
|
|
Week 3 |
$650.00 |
$450.00 |
$200.00 |
$600.00 |
|
|
Week 4 |
$650.00 |
$450.00 |
$200.00 |
$800.00 |
$114.48 |
|
Week 5 |
$650.00 |
$450.00 |
$200.00 |
$1,000.00 |
$114.48 |
|
Week 6 |
$650.00 |
$450.00 |
$200.00 |
$1,200.00 |
$114.48 |
|
Week 7 |
$650.00 |
$450.00 |
$200.00 |
$1,400.00 |
$457.92 |
|
Week 8 |
$650.00 |
$450.00 |
$200.00 |
$1,600.00 |
$114.48 |
|
Week 9 |
$650.00 |
$450.00 |
$200.00 |
$1,800.00 |
$114.48 |
|
Week 10 |
$650.00 |
$450.00 |
$200.00 |
$2,000.00 |
$114.48 |
|
Total |
|
|
|
|
$1,144.80 |
Comp Rate Method
|
|
Partial Weekly Benefit Rate |
Cumulative Partial Weekly Benefit Rate |
Weekly Benefits Due |
|
Week 1 |
$114.48 |
|
|
|
Week 2 |
$114.48 |
$228.96 |
|
|
Week 3 |
$114.48 |
$343.44 |
|
|
Week 4 |
$114.48 |
$457.92 |
$40.92 |
|
Week 5 |
$114.48 |
$572.40 |
$114.48 |
|
Week 6 |
$114.48 |
$686.88 |
$114.48 |
|
Week 7 |
$114.48 |
$801.36 |
$114.48 |
|
Week 8 |
$114.48 |
$915.84 |
$531.48 |
|
Week 9 |
$114.48 |
$1,030.32 |
$114.48 |
|
Week 10 |
$114.48 |
$1,144.80 |
$114.48 |
|
Total |
|
$1,144.80 |
$1,144.80 |